Roots Dental LLC

NPI #1205336112 in Portland, Oregon

Provider Information

NPI Number: 1205336112
Entity Type: Organization
Organization Name: Roots Dental LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Feb 16, 2018
Last Updated: Feb 16, 2018

Practice Location

Address: 3620 SE POWELL BLVD # 200
City: Portland
State: Oregon
ZIP Code: 97202-1880
Phone: (716) 601-9468

Authorized Official

Name: RYAN SMITH, DDS
Title: CEO
Phone: (716) 601-9468

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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